Provider Demographics
NPI:1356430383
Name:LARSEN, JANET LYNNE (MD)
Entity type:Individual
Prefix:
First Name:JANET
Middle Name:LYNNE
Last Name:LARSEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 34036
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98124-1036
Mailing Address - Country:US
Mailing Address - Phone:425-899-3292
Mailing Address - Fax:425-899-3269
Practice Address - Street 1:1909 214TH ST. NE
Practice Address - Street 2:SUITE 110
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98021
Practice Address - Country:US
Practice Address - Phone:425-488-4988
Practice Address - Fax:425-488-4993
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD60332782207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2032029Medicaid
MI0H17630104Medicare ID - Type Unspecified
MI4647349Medicaid